MEDICARE: SYDNEY GAYLE JOLLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker		UT

General Provider Information

NPI Number	:	1295663078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY GAYLE JOLLEY

Provider Business Mailing Address
First Line	:	12077 S 1390 W
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-7445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12077 S 1390 W
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-7445
Country	:	US
Telephone Number	:	801-867-9777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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Directions to “ SYDNEY GAYLE JOLLEY ” Practice Location

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